To amend the Public Health Service Act to
extend and improve protections and services to individuals directly impacted by
the terrorist attack in New York City on September 11, 2001, and for other
purposes.

1.

Short title; table of
contents

(a)

Short
title

This Act may be cited
as the James Zadroga 9/11 Health and
Compensation Act of 2010.

The
Public Health Service Act is amended
by adding at the end the following new title:

XXXIII

World Trade
Center Health Program

A

Establishment of
Program; Advisory Committee

3301.

Establishment
of World Trade Center Health Program

(a)

In
general

There is hereby established within the Department of
Health and Human Services a program to be known as the World Trade Center
Health Program, which shall be administered by the WTC Program Administrator,
to provide beginning on July 1, 2011—

(1)

medical monitoring and treatment benefits
to eligible emergency responders and recovery and cleanup workers (including
those who are Federal employees) who responded to the September 11, 2001,
terrorist attacks; and

(2)

initial health
evaluation, monitoring, and treatment benefits to residents and other building
occupants and area workers in New York City who were directly impacted and
adversely affected by such attacks.

(b)

Components of
Program

The WTC Program includes the following components:

(1)

Medical
monitoring for responders

Medical monitoring under section 3311,
including clinical examinations and long-term health monitoring and analysis
for enrolled WTC responders who were likely to have been exposed to airborne
toxins that were released, or to other hazards, as a result of the September
11, 2001, terrorist attacks.

(2)

Initial health
evaluation for survivors

An
initial health evaluation under section 3321, including an evaluation to
determine eligibility for followup monitoring and treatment.

(3)

Followup
monitoring and treatment for WTC-related health conditions for responders and
survivors

Provision under sections 3312, 3322, and 3323 of
followup monitoring and treatment and payment, subject to the provisions of
subsection (d), for all medically necessary health and mental health care
expenses of an individual with respect to a WTC-related health condition
(including necessary prescription drugs).

(4)

Outreach

Establishment under section 3303 of an
education and outreach program to potentially eligible individuals concerning
the benefits under this title.

(5)

Clinical data
collection and analysis

Collection and analysis under section
3304 of health and mental health data relating to individuals receiving
monitoring or treatment benefits in a uniform manner in collaboration with the
collection of epidemiological data under section 3342.

(6)

Research on
health conditions

Establishment under subtitle C of a research
program on health conditions resulting from the September 11, 2001, terrorist
attacks.

(c)

No cost
sharing

Monitoring and
treatment benefits and initial health evaluation benefits are provided under
subtitle B without any deductibles, copayments, or other cost sharing to an
enrolled WTC responder or certified-eligible WTC survivor. Initial health
evaluation benefits are provided under subtitle B without any deductibles,
copayments, or other cost sharing to a screening-eligible WTC survivor.

(d)

Preventing fraud
and unreasonable administrative costs

(1)

Fraud

The
Inspector General of the Department of Health and Human Services shall develop
and implement a program to review the WTC Program’s health care expenditures to
detect fraudulent or duplicate billing and payment for inappropriate services.
This title is a Federal health care program (as defined in section 1128B(f) of
the Social Security Act) and is a health plan (as defined in section 1128C(c)
of such Act) for purposes of applying sections 1128 through 1128E of such
Act.

(2)

Unreasonable
administrative costs

The
Inspector General of the Department of Health and Human Services shall develop
and implement a program to review the WTC Program for unreasonable
administrative costs, including with respect to infrastructure, administration,
and claims processing.

(e)

Quality
assurance

The WTC Program
Administrator working with the Clinical Centers of Excellence shall develop and
implement a quality assurance program for the monitoring and treatment
delivered by such Centers of Excellence and any other participating health care
providers. Such program shall include—

(1)

adherence to
monitoring and treatment protocols;

(2)

appropriate
diagnostic and treatment referrals for participants;

(3)

prompt
communication of test results to participants; and

(4)

such other
elements as the Administrator specifies in consultation with the Clinical
Centers of Excellence.

(f)

Annual program
report

(1)

In
general

Not later than 6
months after the end of each fiscal year in which the WTC Program is in
operation, the WTC Program Administrator shall submit an annual report to the
Congress on the operations of this title for such fiscal year and for the
entire period of operation of the program.

(2)

Contents
included in report

Each
annual report under paragraph (1) shall include at least the following:

(A)

Eligible
individuals

Information for
each clinical program described in paragraph (3)—

(i)

on the number of individuals who applied
for certification under subtitle B and the number of such individuals who were
so certified;

(ii)

of the
individuals who were certified, on the number who received monitoring under the
program and the number of such individuals who received medical treatment under
the program;

(iii)

with respect to
individuals so certified who received such treatment, on the WTC-related health
conditions for which they were treated; and

(iv)

on the projected number of individuals who
will be certified under subtitle B in the succeeding fiscal year and the
succeeding 10-year period.

(B)

Monitoring,
initial health evaluation, and treatment costs

For each clinical
program so described—

(i)

information on the
costs of monitoring and initial health evaluation and the costs of treatment
and on the estimated costs of such monitoring, evaluation, and treatment in the
succeeding fiscal year; and

(ii)

an estimate of
the cost of medical treatment for WTC-related health conditions that have been
paid for or reimbursed by workers’ compensation, by public or private health
plans, or by New York City under section 3331.

(C)

Administrative
costs

Information on the cost of administering the program,
including costs of program support, data collection and analysis, and research
conducted under the program.

(D)

Administrative
experience

Information on the administrative performance of the
program, including—

(i)

the performance of
the program in providing timely evaluation of and treatment to eligible
individuals; and

(ii)

a
list of the Clinical Centers of Excellence and other providers that are
participating in the program.

(E)

Scientific
reports

A summary of the
findings of any new scientific reports or studies on the health effects
associated with exposure described in section 3306(1), including the findings
of research conducted under section 3341(a).

(F)

Advisory
committee recommendations

A list of recommendations by the WTC
Scientific/Technical Advisory Committee on additional WTC Program eligibility
criteria and on additional WTC-related health conditions and the action of the
WTC Program Administrator concerning each such recommendation.

(3)

Separate
clinical programs described

In paragraph (2), each of the
following shall be treated as a separate clinical program of the WTC
Program:

(A)

Firefighters and
related personnel

The benefits provided for enrolled WTC
responders described in section 3311(a)(2)(A).

(B)

Other WTC
responders

The benefits
provided for enrolled WTC responders not described in subparagraph (A).

The Secretary shall promptly notify the
Congress of each of the following:

(1)

When the number of
enrollments of WTC responders subject to the limit established under section
3311(a)(4) has reached 80 percent of such limit.

(2)

When the number of certifications for
certified-eligible WTC survivors subject to the limit established under section
3321(a)(3) has reached 80 percent of such limit.

(h)

Consultation

The WTC Program Administrator shall engage
in ongoing outreach and consultation with relevant stakeholders, including the
WTC Health Program Steering Committees and the Advisory Committee under section
3302, regarding the implementation and improvement of programs under this
title.

The WTC Program Administrator shall
establish an advisory committee to be known as the WTC Health Program
Scientific/Technical Advisory Committee (in this subsection referred to as the
Advisory Committee) to review scientific and medical evidence
and to make recommendations to the Administrator on additional WTC Program
eligibility criteria and on additional WTC-related health conditions.

(2)

Composition

The WTC Program Administrator shall appoint
the members of the Advisory Committee and shall include at least—

The
WTC Program Administrator shall consult with 2 steering committees (each in
this section referred to as a Steering Committee) that are
established as follows:

(A)

WTC responders
steering committee

One Steering Committee, to be known as the WTC
Responders Steering Committee, for the purpose of receiving input from affected
stakeholders and facilitating the coordination of monitoring and treatment
programs for the enrolled WTC responders under part 1 of subtitle B.

(B)

WTC survivors
steering committee

One Steering Committee, to be known as the WTC
Survivors Steering Committee, for the purpose of receiving input from affected
stakeholders and facilitating the coordination of initial health evaluations,
monitoring, and treatment programs for screening-eligible and
certified-eligible WTC survivors under part 2 of subtitle B.

(2)

Membership

(A)

WTC responders
steering committee

(i)

Representation

The
WTC Responders Steering Committee shall include—

(I)

representatives of the Centers of
Excellence providing services to WTC responders;

(II)

representatives
of labor organizations representing firefighters, police, other New York City
employees, and recovery and cleanup workers who responded to the September 11,
2001, terrorist attacks; and

(III)

3
representatives of New York City, 1 of whom will be selected by the police
commissioner of New York City, 1 by the health commissioner of New York City,
and 1 by the mayor of New York City.

(ii)

Initial
membership

The WTC Responders Steering Committee shall initially
be composed of members of the WTC Monitoring and Treatment Program Steering
Committee (as in existence on the day before the date of the enactment of this
title).

the Centers of
Excellence providing services to screening-eligible and certified-eligible WTC
survivors;

(II)

the population of
residents, students, and area and other workers affected by the September 11,
2001, terrorist attacks;

(III)

screening-eligible and certified-eligible
survivors receiving initial health evaluations, monitoring, or treatment under
part 2 of subtitle B and organizations advocating on their behalf; and

(IV)

New York
City.

(ii)

Initial
membership

The WTC Survivors Steering Committee shall initially
be composed of members of the WTC Environmental Health Center Survivor Advisory
Committee (as in existence on the day before the date of the enactment of this
title).

(C)

Additional
appointments

Each Steering Committee may recommend, if approved
by a majority of voting members of the Committee, additional members to the
Committee.

(D)

Vacancies

A
vacancy in a Steering Committee shall be filled by an individual recommended by
the Steering Committee.

3303.

Education and
outreach

The WTC Program
Administrator shall institute a program that provides education and outreach on
the existence and availability of services under the WTC Program. The outreach
and education program—

(1)

shall include—

(A)

the establishment
of a public Web site with information about the WTC Program;

(B)

meetings with
potentially eligible populations;

(C)

development and
dissemination of outreach materials informing people about the program;
and

(D)

the establishment
of phone information services; and

(2)

shall be conducted
in a manner intended—

(A)

to reach all
affected populations; and

(B)

to include
materials for culturally and linguistically diverse populations.

3304.

Uniform data
collection and analysis

(a)

In
general

The WTC Program
Administrator shall provide for the uniform collection of data (and analysis of
data and regular reports to the Administrator) on the prevalence of WTC-related
health conditions and the identification of new WTC-related health conditions.
Such data shall be collected for all individuals provided monitoring or
treatment benefits under subtitle B and regardless of their place of residence
or Clinical Center of Excellence through which the benefits are provided. The
WTC Program Administrator shall provide, through the Data Centers or otherwise,
for the integration of such data into the monitoring and treatment program
activities under this title.

(b)

Coordinating
through Centers of Excellence

Each Clinical Center of Excellence
shall collect data described in subsection (a) and report such data to the
corresponding Data Center for analysis by such Data Center.

(c)

Collaboration
with WTC health registry

The WTC Program Administrator shall
provide for collaboration between the Data Centers and the World Trade Center
Health Registry described in section 3342.

(d)

Privacy

The data collection and analysis under this
section shall be conducted and maintained in a manner that protects the
confidentiality of individually identifiable health information consistent with
applicable statutes and regulations, including, as applicable, HIPAA privacy
and security law (as defined in section 3009(a)(2)) and section 552a of title
5, United States Code.

3305.

Clinical
Centers of Excellence and Data Centers

(a)

In
general

(1)

Contracts with
clinical centers of excellence

The WTC Program Administrator shall,
subject to subsection (b)(1)(B), enter into contracts with Clinical Centers of
Excellence (as defined in subsection (b)(1)(A))—

(A)

for the provision
of monitoring and treatment benefits and initial health evaluation benefits
under subtitle B;

(B)

for the provision of outreach activities to
individuals eligible for such monitoring and treatment benefits, for initial
health evaluation benefits, and for followup to individuals who are enrolled in
the monitoring program;

(C)

for the provision
of counseling for benefits under subtitle B, with respect to WTC-related health
conditions, for individuals eligible for such benefits;

(D)

for the provision of counseling for
benefits for WTC-related health conditions that may be available under workers’
compensation or other benefit programs for work-related injuries or illnesses,
health insurance, disability insurance, or other insurance plans or through
public or private social service agencies and assisting eligible individuals in
applying for such benefits;

(E)

for the provision of translational and
interpretive services for program participants who are not English language
proficient; and

(F)

for the collection
and reporting of data in accordance with section 3304.

(2)

Contracts with
data centers

(A)

In
general

The WTC Program Administrator shall enter into contracts
with Data Centers (as defined in subsection (b)(2))—

(i)

for receiving,
analyzing, and reporting to the WTC Program Administrator on data, in
accordance with section 3304, that have been collected and reported to such
Data Centers by the corresponding Clinical Centers of Excellence under
subsection (b)(1)(B)(iii);

(ii)

for the
development of monitoring, initial health evaluation, and treatment protocols,
with respect to WTC-related health conditions;

(iii)

for coordinating
the outreach activities conducted under paragraph (1)(B) by each corresponding
Clinical Center of Excellence;

(iv)

for establishing
criteria for the credentialing of medical providers participating in the
nationwide network under section 3313;

(v)

for coordinating
and administering the activities of the WTC Health Program Steering Committees
established under section 3002(b); and

(vi)

for meeting periodically with the
corresponding Clinical Centers of Excellence to obtain input on the analysis
and reporting of data collected under clause (i) and on the development of
monitoring, initial health evaluation, and treatment protocols under clause
(ii).

(B)

Medical provider
selection

The medical providers under subparagraph (A)(iv) shall
be selected by the WTC Program Administrator on the basis of their experience
treating or diagnosing the health conditions included in the list of
WTC-related health conditions.

(C)

Clinical
discussions

In carrying out
subparagraph (A)(ii), a Data Center shall engage in clinical discussions across
the WTC Program to guide treatment approaches for individuals with a
WTC-related health condition.

(D)

Transparency of
data

A contract entered into under this subsection with a Data
Center shall require the Data Center to make any data collected and reported to
such Center under subsection (b)(1)(B)(iii) available to health researchers and
others as provided in the CDC/ATSDR Policy on Releasing and Sharing
Data.

(3)

Authority for
contracts to be class specific

A contract entered into under this
subsection with a Clinical Center of Excellence or a Data Center may be with
respect to one or more class of enrolled WTC responders, screening-eligible WTC
survivors, or certified-eligible WTC survivors.

(4)

Use of
cooperative agreements

Any contract under this title between the
WTC Program Administrator and a Data Center or a Clinical Center of Excellence
may be in the form of a cooperative agreement.

(b)

Centers of
excellence

(1)

Clinical Centers
of Excellence

(A)

Definition

For
purposes of this title, the term Clinical Center of Excellence
means a Center that demonstrates to the satisfaction of the Administrator that
the Center—

(i)

uses an integrated, centralized health care
provider approach to create a comprehensive suite of health services under this
title that are accessible to enrolled WTC responders, screening-eligible WTC
survivors, or certified-eligible WTC survivors;

(ii)

has experience in
caring for WTC responders and screening-eligible WTC survivors or includes
health care providers who have been trained pursuant to section 3313(c);

(iii)

employs health
care provider staff with expertise that includes, at a minimum, occupational
medicine, environmental medicine, trauma-related psychiatry and psychology, and
social services counseling; and

(iv)

meets such other
requirements as specified by the Administrator.

(B)

Contract
requirements

The WTC Program Administrator shall not enter into a
contract with a Clinical Center of Excellence under subsection (a)(1) unless
the Center agrees to do each of the following:

(i)

Establish a formal
mechanism for consulting with and receiving input from representatives of
eligible populations receiving monitoring and treatment benefits under subtitle
B from such Center.

(ii)

Coordinate
monitoring and treatment benefits under subtitle B with routine medical care
provided for the treatment of conditions other than WTC-related health
conditions.

(iii)

Collect and
report to the corresponding Data Center data in accordance with section
3304(b).

(iv)

Have in place safeguards against fraud that
are satisfactory to the Administrator, in consultation with the Inspector
General of the Department of Health and Human Services.

(v)

Treat or refer for
treatment all individuals who are enrolled WTC responders or certified-eligible
WTC survivors with respect to such Center who present themselves for treatment
of a WTC-related health condition.

(vi)

Have in place
safeguards, consistent with section 3304(c), to ensure the confidentiality of
an individual’s individually identifiable health information, including
requiring that such information not be disclosed to the individual’s employer
without the authorization of the individual.

(vii)

Use amounts paid under subsection (c)(1)
only for costs incurred in carrying out the activities described in subsection
(a), other than those described in subsection (a)(1)(A).

(viii)

Utilize health
care providers with occupational and environmental medicine expertise to
conduct physical and mental health assessments, in accordance with protocols
developed under subsection (a)(2)(A)(ii).

(ix)

Communicate with
WTC responders and screening-eligible and certified-eligible WTC survivors in
appropriate languages and conduct outreach activities with relevant stakeholder
worker or community associations.

(x)

Meet all the other
applicable requirements of this title, including regulations implementing such
requirements.

(C)

Transition rule
to ensure continuity of care

The WTC Program Administrator shall to the
maximum extent feasible ensure continuity of care in any period of transition
from monitoring and treatment of an enrolled WTC responder or
certified-eligible WTC survivor by a provider to a Clinical Center of
Excellence or a health care provider participating in the nationwide network
under section 3313.

(2)

Data
Centers

For purposes of this
title, the term Data Center means a Center that the WTC Program
Administrator determines has the capacity to carry out the responsibilities for
a Data Center under subsection (a)(2).

(3)

Corresponding
centers

For purposes of this title, a Clinical Center of
Excellence and a Data Center shall be treated as corresponding
to the extent that such Clinical Center and Data Center serve the same
population group.

(c)

Payment for
infrastructure costs

(1)

In
general

The WTC Program Administrator shall reimburse a Clinical
Center of Excellence for the fixed infrastructure costs of such Center in
carrying out the activities described in subtitle B at a rate negotiated by the
Administrator and such Centers. Such negotiated rate shall be fair and
appropriate and take into account the number of enrolled WTC responders
receiving services from such Center under this title.

(2)

Fixed
infrastructure costs

For purposes of paragraph (1), the term
fixed infrastructure costs means, with respect to a Clinical
Center of Excellence, the costs incurred by such Center that are not
reimbursable by the WTC Program Administrator under section 3312(c).

3306.

Definitions

In this title:

(1)

The term aggravating means,
with respect to a health condition, a health condition that existed on
September 11, 2001, and that, as a result of exposure to airborne toxins, any
other hazard, or any other adverse condition resulting from the September 11,
2001, terrorist attacks, requires medical treatment that is (or will be) in
addition to, more frequent than, or of longer duration than the medical
treatment that would have been required for such condition in the absence of
such exposure.

(2)

The term
certified-eligible WTC survivor has the meaning given such term
in section 3321(a)(2).

(3)

The terms
Clinical Center of Excellence and Data Center have
the meanings given such terms in section 3305.

(4)

The term enrolled WTC
responder means a WTC responder enrolled under section
3311(a)(3).

(5)

The term initial health
evaluation includes, with respect to an individual, a medical and
exposure history, a physical examination, and additional medical testing as
needed to evaluate whether the individual has a WTC-related health condition
and is eligible for treatment under the WTC Program.

(6)

The term
list of WTC-related health conditions means—

(A)

for WTC responders, the health conditions
listed in section 3312(a)(3); and

(B)

for screening-eligible and
certified-eligible WTC survivors, the health conditions listed in section
3322(b).

(7)

The term New
York City disaster area means the area within New York City that
is—

(A)

the area of
Manhattan that is south of Houston Street; and

(B)

any block in
Brooklyn that is wholly or partially contained within a 1.5-mile radius of the
former World Trade Center site.

(8)

The term New York metropolitan
area means an area, specified by the WTC Program Administrator, within
which WTC responders and eligible WTC screening-eligible survivors who reside
in such area are reasonably able to access monitoring and treatment benefits
and initial health evaluation benefits under this title through a Clinical
Center of Excellence described in subparagraphs (A), (B), or (C) of section
3305(b)(1).

(9)

The term
screening-eligible WTC survivor has the meaning given such term
in section 3321(a)(1).

(10)

Any reference to
September 11, 2001 shall be deemed a reference to the period on
such date subsequent to the terrorist attacks at the World Trade Center,
Shanksville, Pennsylvania, or the Pentagon, as applicable, on such date.

(11)

The term September 11, 2001,
terrorist attacks means the terrorist attacks that occurred on
September 11, 2001, in New York City, in Shanksville, Pennsylvania, and at the
Pentagon, and includes the aftermath of such attacks.

(12)

The term
WTC Health Program Steering Committee means such a Steering
Committee established under section 3302(b).

(13)

The term
WTC Program means the Word Trade Center Health Program
established under section 3301(a).

(14)

The term
WTC Program Administrator means—

(A)

with respect to
paragraphs (3) and (4) of section 3311(a) (relating to enrollment of WTC
responders), section 3312(c) and the corresponding provisions of section 3322
(relating to payment for initial health evaluation, monitoring, and treatment),
paragraphs (1)(C), (2)(B), and (3) of section 3321(a) (relating to
determination or certification of screening-eligible or certified-eligible WTC
responders), and part 3 of subtitle B (relating to payor provisions), an
official in the Department of Health and Human Services, to be designated by
the Secretary; and

(B)

with respect to
any other provision of this title, the Director of the National Institute for
Occupational Safety and Health, or a designee of such Director.

(15)

The term
WTC-related health condition is defined in section 3312(a).

(16)

The term
WTC responder is defined in section 3311(a).

(17)

The term
WTC Scientific/Technical Advisory Committee means such Committee
established under section 3302(a).

B

Program of
Monitoring, Initial Health Evaluations, and Treatment

1

WTC
Responders

3311.

Identification
of WTC responders and provision of WTC-related monitoring services

(a)

WTC responder
defined

(1)

In
general

For purposes of this title, the term WTC
responder means any of the following individuals, subject to paragraph
(4):

(A)

Currently
identified responder

An individual who has been identified as
eligible for monitoring under the arrangements as in effect on the date of the
enactment of this title between the National Institute for Occupational Safety
and Health and—

(i)

the consortium
coordinated by Mt. Sinai Hospital in New York City that coordinates the
monitoring and treatment for enrolled WTC responders other than with respect to
those covered under the arrangement with the Fire Department of New York City;
or

(ii)

the Fire
Department of New York City.

(B)

Responder who
meets current eligibility criteria

An individual who meets the
current eligibility criteria described in paragraph (2).

(C)

Responder who
meets modified eligibility criteria

An individual who—

(i)

performed rescue,
recovery, demolition, debris cleanup, or other related services in the New York
City disaster area in response to the September 11, 2001, terrorist attacks,
regardless of whether such services were performed by a State or Federal
employee or member of the National Guard or otherwise; and

(ii)

meets such
eligibility criteria relating to exposure to airborne toxins, other hazards, or
adverse conditions resulting from the September 11, 2001, terrorist attacks as
the WTC Program Administrator, after consultation with the WTC
Scientific/Technical Advisory Committee, determines appropriate.

The WTC Program Administrator
shall not modify such eligibility criteria on or after the date that the number
of enrollments of WTC responders has reached 80 percent of the limit described
in paragraph (4) or on or after the date that the number of certifications for
certified-eligible WTC survivors under section 3321(a)(2)(B) has reached 80
percent of the limit described in section 3321(a)(3).(2)

Current
eligibility criteria

The eligibility criteria described in this
paragraph for an individual is that the individual is described in any of the
following categories:

(A)

Firefighters and
related personnel

The individual—

(i)

was a member of
the Fire Department of New York City (whether fire or emergency personnel,
active or retired) who participated at least one day in the rescue and recovery
effort at any of the former World Trade Center sites (including Ground Zero,
Staten Island Landfill, and the New York City Chief Medical Examiner’s Office)
for any time during the period beginning on September 11, 2001, and ending on
July 31, 2002; or

(ii)(I)

is a surviving immediate family member of
an individual who was a member of the Fire Department of New York City (whether
fire or emergency personnel, active or retired) and was killed at the World
Trade site on September 11, 2001; and

(II)

received any treatment for a WTC-related
health condition described in section 3312(a)(1)(A)(ii) (relating to mental
health conditions) on or before September 1, 2008.

(B)

Law enforcement
officers and WTC rescue, recovery, and cleanup workers

The
individual—

(i)

worked or
volunteered onsite in rescue, recovery, debris cleanup, or related support
services in lower Manhattan (south of Canal St.), the Staten Island Landfill,
or the barge loading piers, for at least 4 hours during the period beginning on
September 11, 2001, and ending on September 14, 2001, for at least 24 hours
during the period beginning on September 11, 2001, and ending on September 30,
2001, or for at least 80 hours during the period beginning on September 11,
2001, and ending on July 31, 2002;

(ii)(I)

was a member of the
Police Department of New York City (whether active or retired) or a member of
the Port Authority Police of the Port Authority of New York and New Jersey
(whether active or retired) who participated onsite in rescue, recovery, debris
cleanup, or related services in lower Manhattan (south of Canal St.), including
Ground Zero, the Staten Island Landfill, or the barge loading piers, for at
least 4 hours during the period beginning September 11, 2001, and ending on
September 14, 2001;

(II)

participated onsite in rescue, recovery,
debris cleanup, or related services in at Ground Zero, the Staten Island
Landfill, or the barge loading piers, for at least one day during the period
beginning on September 11, 2001, and ending on July 31, 2002;

(III)

participated onsite in rescue,
recovery, debris cleanup, or related services in lower Manhattan (south of
Canal St.) for at least 24 hours during the period beginning on September 11,
2001, and ending on September 30, 2001; or

(IV)

participated onsite in rescue, recovery,
debris cleanup, or related services in lower Manhattan (south of Canal St.) for
at least 80 hours during the period beginning on September 11, 2001, and ending
on July 31, 2002;

(iii)

was an employee of the Office of the Chief
Medical Examiner of New York City involved in the examination and handling of
human remains from the World Trade Center attacks, or other morgue worker who
performed similar post-September 11 functions for such Office staff, during the
period beginning on September 11, 2001, and ending on July 31, 2002;

(iv)

was a worker in
the Port Authority Trans-Hudson Corporation Tunnel for at least 24 hours during
the period beginning on February 1, 2002, and ending on July 1, 2002; or

(v)

was a
vehicle-maintenance worker who was exposed to debris from the former World
Trade Center while retrieving, driving, cleaning, repairing, and maintaining
vehicles contaminated by airborne toxins from the September 11, 2001, terrorist
attacks during a duration and period described in subparagraph (A).

(C)

Responders to
the September 11 attacks at the Pentagon and Shanksville,
Pennsylvania

The
individual—

(i)(I)

was a member of a fire
or police department (whether fire or emergency personnel, active or retired),
worked for a recovery or cleanup contractor, or was a volunteer; and performed
rescue, recovery, demolition, debris cleanup, or other related services at the
Pentagon site of the terrorist-related aircraft crash of September 11, 2001,
during the period beginning on September 11, 2001, and ending on the date on
which the cleanup of the site was concluded, as determined by the WTC Program
Administrator; or

(II)

was
a member of a fire or police department (whether fire or emergency personnel,
active or retired), worked for a recovery or cleanup contractor, or was a
volunteer; and performed rescue, recovery, demolition, debris cleanup, or other
related services at the Shanksville, Pennsylvania, site of the
terrorist-related aircraft crash of September 11, 2001, during the period
beginning on September 11, 2001, and ending on the date on which the cleanup of
the site was concluded, as determined by the WTC Program Administrator;
and

(ii)

is determined by
the WTC Program Administrator to be at an increased risk of developing a
WTC-related health condition as a result of exposure to airborne toxins, other
hazards, or adverse conditions resulting from the September 11, 2001, terrorist
attacks, and meets such eligibility criteria related to such exposures, as the
WTC Program Administrator determines are appropriate, after consultation with
the WTC Scientific/Technical Advisory Committee.

(3)

Enrollment
process

(A)

In
general

The WTC Program Administrator shall establish a process
for enrolling WTC responders in the WTC Program. Under such process—

(i)

WTC responders
described in paragraph (1)(A) shall be deemed to be enrolled in such
Program;

(ii)

subject to clause
(iii), the Administrator shall enroll in such program individuals who are
determined to be WTC responders;

(iii)

the
Administrator shall deny such enrollment to an individual if the Administrator
determines that the numerical limitation in paragraph (4) on enrollment of WTC
responders has been met;

(iv)

there shall be no
fee charged to the applicant for making an application for such
enrollment;

(v)

the Administrator
shall make a determination on such an application not later than 60 days after
the date of filing the application; and

(vi)

an individual who
is denied enrollment in such Program shall have an opportunity to appeal such
determination in a manner established under such process.

(B)

Timing

(i)

Currently
identified responders

In accordance with subparagraph (A)(i), the
WTC Program Administrator shall enroll an individual described in paragraph
(1)(A) in the WTC Program not later than July 1, 2011.

(ii)

Other
responders

In accordance with subparagraph (A)(ii) and consistent
with paragraph (4), the WTC Program Administrator shall enroll any other
individual who is determined to be a WTC responder in the WTC Program at the
time of such determination.

(4)

Numerical
limitation on eligible WTC responders

(A)

In
general

The total number of
individuals not described in paragraph (1)(A) or (2)(A)(ii) who may be enrolled
under paragraph (3)(A)(ii) shall not exceed 25,000 at any time, of which no
more than 2,500 may be individuals enrolled based on modified eligibility
criteria established under paragraph (1)(C).

(B)

Process

In
implementing subparagraph (A), the WTC Program Administrator shall—

(i)

limit the number
of enrollments made under paragraph (3)—

(I)

in accordance with
such subparagraph; and

(II)

to such number,
as determined by the Administrator based on the best available information and
subject to amounts available under section 3351, that will ensure sufficient
funds will be available to provide treatment and monitoring benefits under this
title, with respect to all individuals who are enrolled through the end of
fiscal year 2020; and

(ii)

provide priority (subject to paragraph
(3)(A)(i)) in such enrollments in the order in which individuals apply for
enrollment under paragraph (3).

(5)

Disqualification
of individuals on terrorist watch list

No individual who is on the terrorist watch
list maintained by the Department of Homeland Security shall qualify as an
eligible WTC responder. Before enrolling any individual as a WTC responder in
the WTC Program under paragraph (3), the Administrator, in consultation with
the Secretary of Homeland Security, shall determine whether the individual is
on such list.

(b)

Monitoring
Benefits

(1)

In
general

In the case of an
enrolled WTC responder (other than one described in subsection (a)(2)(A)(ii)),
the WTC Program shall provide for monitoring benefits that include monitoring
consistent with protocols approved by the WTC Program Administrator and
including clinical examinations and long-term health monitoring and analysis.
In the case of an enrolled WTC responder who is an active member of the Fire
Department of New York City, the responder shall receive such benefits as part
of the individual’s periodic company medical exams.

(2)

Provision of
monitoring benefits

The
monitoring benefits under paragraph (1) shall be provided through the Clinical
Center of Excellence for the type of individual involved or, in the case of an
individual residing outside the New York metropolitan area, under an
arrangement under section 3313.

For purposes of this title, the term WTC-related
health condition means a condition that—

(A)(i)

is an illness or health
condition for which exposure to airborne toxins, any other hazard, or any other
adverse condition resulting from the September 11, 2001, terrorist attacks,
based on an examination by a medical professional with experience in treating
or diagnosing the health conditions included in the applicable list of
WTC-related health conditions, is substantially likely to be a significant
factor in aggravating, contributing to, or causing the illness or health
condition, as determined under paragraph (2); or

(ii)

is a mental health condition for which such
attacks, based on an examination by a medical professional with experience in
treating or diagnosing the health conditions included in the applicable list of
WTC-related health conditions, is substantially likely to be a significant
factor in aggravating, contributing to, or causing the condition, as determined
under paragraph (2); and

(B)

is included in the
applicable list of WTC-related health conditions or—

(i)

with respect to a
WTC responder, is provided certification of coverage under subsection
(b)(2)(B)(iii); or

(ii)

with respect to a screening-eligible WTC
survivor or certified-eligible WTC survivor, is provided certification of
coverage under subsection (b)(2)(B)(iii), as applied under section
3322(a).

In the
case of a WTC responder described in section 3311(a)(2)(A)(ii) (relating to a
surviving immediate family member of a firefighter), such term does not include
an illness or health condition described in subparagraph (A)(i).(2)

Determination

The
determination under paragraph (1) or subsection (b) of whether the September
11, 2001, terrorist attacks were substantially likely to be a significant
factor in aggravating, contributing to, or causing an individual’s illness or
health condition shall be made based on an assessment of the following:

(A)

The individual’s
exposure to airborne toxins, any other hazard, or any other adverse condition
resulting from the terrorist attacks. Such exposure shall be—

(i)

evaluated and
characterized through the use of a standardized, population-appropriate
questionnaire approved by the Director of the National Institute for
Occupational Safety and Health; and

(ii)

assessed and
documented by a medical professional with experience in treating or diagnosing
health conditions included on the list of WTC-related health conditions.

(B)

The type of
symptoms and temporal sequence of symptoms. Such symptoms shall be—

(i)

assessed through the use of a standardized,
population-appropriate medical questionnaire approved by the Director of the
National Institute for Occupational Safety and Health and a medical
examination; and

(ii)

diagnosed and
documented by a medical professional described in subparagraph (A)(ii).

(3)

List of health
conditions for WTC responders

The list of health conditions for
WTC responders consists of the following:

(A)

Aerodigestive
disorders

(i)

Interstitial lung
diseases.

(ii)

Chronic
respiratory disorder—fumes/vapors.

(iii)

Asthma.

(iv)

Reactive airways
dysfunction syndrome (RADS).

(v)

WTC-exacerbated
chronic obstructive pulmonary disease (COPD).

(vi)

Chronic cough
syndrome.

(vii)

Upper airway
hyperreactivity.

(viii)

Chronic
rhinosinusitis.

(ix)

Chronic
nasopharyngitis.

(x)

Chronic
laryngitis.

(xi)

Gastroesophageal
reflux disorder (GERD).

(xii)

Sleep apnea
exacerbated by or related to a condition described in a previous clause.

(B)

Mental health
conditions

(i)

Posttraumatic
stress disorder (PTSD).

(ii)

Major depressive
disorder.

(iii)

Panic
disorder.

(iv)

Generalized
anxiety disorder.

(v)

Anxiety disorder
(not otherwise specified).

(vi)

Depression (not
otherwise specified).

(vii)

Acute stress
disorder.

(viii)

Dysthymic
disorder.

(ix)

Adjustment
disorder.

(x)

Substance
abuse.

(C)

Musculoskeletal
disorders for certain WTC responders

In the case of a WTC responder described in
paragraph (4), a condition described in such paragraph.

(D)

Additional
conditions

Any cancer (or type of cancer) or other condition
added, pursuant to paragraph (5) or (6), to the list under this
paragraph.

(4)

Musculoskeletal
disorders

(A)

In
general

For purposes of this title, in the case of a WTC
responder who received any treatment for a WTC-related musculoskeletal disorder
on or before September 11, 2003, the list of health conditions in paragraph (3)
shall include:

(i)

Low back pain.

(ii)

Carpal tunnel
syndrome (CTS).

(iii)

Other
musculoskeletal disorders.

(B)

Definition

The
term WTC-related musculoskeletal disorder means a chronic or
recurrent disorder of the musculoskeletal system caused by heavy lifting or
repetitive strain on the joints or musculoskeletal system occurring during
rescue or recovery efforts in the New York City disaster area in the aftermath
of the September 11, 2001, terrorist attacks.

(5)

Cancer

(A)

In
general

The WTC Program
Administrator shall periodically conduct a review of all available scientific
and medical evidence, including findings and recommendations of Clinical
Centers of Excellence, published in peer-reviewed journals to determine if,
based on such evidence, cancer or a certain type of cancer should be added to
the applicable list of WTC-related health conditions. The WTC Program
Administrator shall conduct the first review under this subparagraph not later
than 180 days after the date of the enactment of this title.

(B)

Proposed
regulations and rulemaking

Based on the periodic reviews under
subparagraph (A), if the WTC Program Administrator determines that cancer or a
certain type of cancer should be added to such list of WTC-related health
conditions, the WTC Program Administrator shall propose regulations, through
rulemaking, to add cancer or the certain type of cancer to such list.

(C)

Final
regulations

Based on all the available evidence in the rulemaking
record, the WTC Program Administrator shall make a final determination of
whether cancer or a certain type of cancer should be added to such list of
WTC-related health conditions. If such a determination is made to make such an
addition, the WTC Program Administrator shall by regulation add cancer or the
certain type of cancer to such list.

(D)

Determinations
not to add cancer or certain types of cancer

In the case that the WTC Program
Administrator determines under subparagraph (B) or (C) that cancer or a certain
type of cancer should not be added to such list of WTC-related health
conditions, the WTC Program Administrator shall publish an explanation for such
determination in the Federal Register. Any such determination to not make such
an addition shall not preclude the addition of cancer or the certain type of
cancer to such list at a later date.

(6)

Addition of
health conditions to list for WTC responders

(A)

In
general

Whenever the WTC Program Administrator determines that a
proposed rule should be promulgated to add a health condition to the list of
health conditions in paragraph (3), the Administrator may request a
recommendation of the Advisory Committee or may publish such a proposed rule in
the Federal Register in accordance with subparagraph (D).

(B)

Administrator’s
options after receipt of petition

In the case that the WTC Program
Administrator receives a written petition by an interested party to add a
health condition to the list of health conditions in paragraph (3), not later
than 60 days after the date of receipt of such petition the Administrator
shall—

(i)

request a
recommendation of the Advisory Committee;

(ii)

publish a
proposed rule in the Federal Register to add such health condition, in
accordance with subparagraph (D);

(iii)

publish in the
Federal Register the Administrator’s determination not to publish such a
proposed rule and the basis for such determination; or

(iv)

publish in the
Federal Register a determination that insufficient evidence exists to take
action under clauses (i) through (iii).

(C)

Action by
Advisory Committee

In the case that the Administrator requests a
recommendation of the Advisory Committee under this paragraph, with respect to
adding a health condition to the list in paragraph (3), the Advisory Committee
shall submit to the Administrator such recommendation not later than 60 days
after the date of such request or by such date (not to exceed 180 days after
such date of request) as specified by the Administrator. Not later than 60 days
after the date of receipt of such recommendation, the Administrator shall, in
accordance with subparagraph (D), publish in the Federal Register a proposed
rule with respect to such recommendation or a determination not to propose such
a proposed rule and the basis for such determination.

(D)

Publication

The
WTC Program Administrator shall, with respect to any proposed rule under this
paragraph—

(i)

publish such
proposed rule in accordance with section 553 of title 5, United States Code;
and

(ii)

provide
interested parties a period of 30 days after such publication to submit written
comments on the proposed rule.

The WTC
Program Administrator may extend the period described in clause (ii) upon a
finding of good cause. In the case of such an extension, the Administrator
shall publish such extension in the Federal Register.(E)

Interested Party
defined

For purposes of this paragraph, the term
interested party includes a representative of any organization
representing WTC responders, a nationally recognized medical association, a
Clinical or Data Center, a State or political subdivision, or any other
interested person.

(b)

Coverage of
Treatment for WTC-Related Health Conditions

(1)

Determination
for enrolled WTC responders based on a WTC-related health condition

(A)

In
general

If a physician at a Clinical Center of Excellence that is
providing monitoring benefits under section 3311 for an enrolled WTC responder
makes a determination that the responder has a WTC-related health condition
that is in the list in subsection (a)(3) and that exposure to airborne toxins,
other hazards, or adverse conditions resulting from the September 1, 2001,
terrorist attacks is substantially likely to be a significant factor in
aggravating, contributing to, or causing the condition—

(i)

the physician
shall promptly transmit such determination to the WTC Program Administrator and
provide the Administrator with the medical facts supporting such determination;
and

(ii)

on and after the date of such transmittal
and subject to subparagraph (B), the WTC Program shall provide for payment
under subsection (c) for medically necessary treatment for such
condition.

(B)

Review;
certification; appeals

(i)

Review

A
Federal employee designated by the WTC Program Administrator shall review
determinations made under subparagraph (A).

(ii)

Certification

The
Administrator shall provide a certification of such condition based upon
reviews conducted under clause (i). Such a certification shall be provided
unless the Administrator determines that the responder’s condition is not a
WTC-related health condition in the list in subsection (a)(3) or that exposure
to airborne toxins, other hazards, or adverse conditions resulting from the
September 1, 2001, terrorist attacks is not substantially likely to be a
significant factor in aggravating, contributing to, or causing the
condition.

(iii)

Appeal
process

The Administrator shall establish, by rule, a process for
the appeal of determinations under clause (ii).

If a physician at a Clinical Center of Excellence
determines pursuant to subsection (a) that the enrolled WTC responder has a
health condition described in subsection (a)(1)(A) that is not in the list in
subsection (a)(3) but which is medically associated with a WTC-related health
condition—

(i)

the physician
shall promptly transmit such determination to the WTC Program Administrator and
provide the Administrator with the facts supporting such determination;
and

(ii)

the Administrator
shall make a determination under subparagraph (B) with respect to such
physician’s determination.

(B)

Procedures for
review, certification, and appeal

The WTC Program Administrator shall, by
rule, establish procedures for the review and certification of physician
determinations under subparagraph (A). Such rule shall provide for—

(i)

the timely review
of such a determination by a physician panel with appropriate expertise for the
condition and recommendations to the WTC Program Administrator;

(ii)

not later than 60
days after the date of the transmittal under subparagraph (A)(i), a
determination by the WTC Program Administrator on whether or not the condition
involved is described in subsection (a)(1)(A) and is medically associated with
a WTC-related health condition;

(iii)

certification in accordance with paragraph
(1)(B)(ii) of coverage of such condition if determined to be described in
subsection (a)(1)(A) and medically associated with a WTC-related health
condition; and

(iv)

a
process for appeals of determinations relating to such conditions.

(C)

Inclusion in
list of health conditions

If the WTC Program Administrator
provides certification under subparagraph (B)(iii) for coverage of a condition,
the Administrator may, pursuant to subsection (a)(6), add the condition to the
list in subsection (a)(3).

(D)

Conditions
already declined for inclusion in list

If the WTC Program Administrator publishes
a determination under subsection (a)(6)(B) not to include a condition in the
list in subsection (a)(3), the WTC Program Administrator shall not provide
certification under subparagraph (B)(iii) for coverage of the condition. In the
case of an individual who is certified under subparagraph (B)(iii) with respect
to such condition before the date of the publication of such determination the
previous sentence shall not apply.

(3)

Requirement of
medical necessity

(A)

In
general

In providing
treatment for a WTC-related health condition, a physician or other provider
shall provide treatment that is medically necessary and in accordance with
medical treatment protocols established under subsection (d).

(B)

Regulations
relating to medical necessity

For the purpose of this title, the
WTC Program Administrator shall issue regulations specifying a standard for
determining medical necessity with respect to health care services and
prescription pharmaceuticals, a process for determining whether treatment
furnished and pharmaceuticals prescribed under this title meet such standard
(including any prior authorization requirement), and a process for appeal of a
determination under subsection (c)(3).

(4)

Scope of
treatment covered

(A)

In
general

The scope of
treatment covered under this subsection includes services of physicians and
other health care providers, diagnostic and laboratory tests, prescription
drugs, inpatient and outpatient hospital services, and other medically
necessary treatment.

(B)

Pharmaceutical
coverage

With respect to ensuring coverage of medically necessary
outpatient prescription drugs, such drugs shall be provided, under arrangements
made by the WTC Program Administrator, directly through participating Clinical
Centers of Excellence or through one or more outside vendors.

(C)

Transportation
expenses for nationwide network

The WTC Program Administrator may
provide for necessary and reasonable transportation and expenses incident to
the securing of medically necessary treatment through the nationwide network
under section 3313 involving travel of more than 250 miles and for which
payment is made under this section in the same manner in which individuals may
be furnished necessary and reasonable transportation and expenses incident to
services involving travel of more than 250 miles under regulations implementing
section 3629(c) of the Energy Employees Occupational Illness Compensation
Program Act of 2000 (title XXXVI of Public Law 106–398; 42 U.S.C.
7384t(c)).

(5)

Provision of
treatment pending certification

With respect to an enrolled WTC responder
for whom a determination is made by an examining physician under paragraph (1)
or (2), but for whom the WTC Program Administrator has not yet determined
whether to certify the determination, the WTC Program Administrator may
establish by rule a process through which the Administrator may approve the
provision of medical treatment under this subsection (and payment under
subsection (c)) with respect to such responder and such responder’s WTC-related
health condition (under such terms and conditions as the Administrator may
provide) until the Administrator makes a decision on whether to certify the
determination.

Subject to
subparagraphs (B) and (C), the WTC Program Administrator shall reimburse costs
for medically necessary treatment under this title for WTC-related health
conditions according to the payment rates that would apply to the provision of
such treatment and services by the facility under the Federal Employees
Compensation Act. For treatment not covered under the previous sentence or
subparagraph (B), the WTC Program Administrator shall establish by regulation a
reimbursement rate for such treatment.

(B)

Pharmaceuticals

(i)

In
general

The WTC Program Administrator shall establish a program
for paying for the medically necessary outpatient prescription pharmaceuticals
prescribed under this title for WTC-related health conditions through one or
more contracts with outside vendors.

(ii)

Competitive
bidding

Under such program the Administrator shall—

(I)

select one or more
appropriate vendors through a Federal competitive bid process; and

(II)

select the lowest
bidder (or bidders) meeting the requirements for providing pharmaceutical
benefits for participants in the WTC Program.

(iii)

Treatment of
FDNY participants

Under such program the Administrator may enter
into an agreement with a separate vendor to provide pharmaceutical benefits to
enrolled WTC responders for whom the Clinical Center of Excellence is described
in section 3305 if such an arrangement is deemed necessary and beneficial to
the program by the WTC Program Administrator.

(C)

Improving
quality and efficiency through modification of payment amounts and
methodologies

The WTC Program Administrator may modify the
amounts and methodologies for making payments for initial health evaluations,
monitoring, or treatment, if, taking into account utilization and quality data
furnished by the Clinical Centers of Excellence under section
3305(b)(1)(B)(iii), the Administrator determines that a bundling, capitation,
pay for performance, or other payment methodology would better ensure high
quality and efficient delivery of initial health evaluations, monitoring, or
treatment to an enrolled WTC responder, screening-eligible WTC survivor, or
certified-eligible WTC survivor.

(2)

Monitoring and
initial health evaluation

The WTC Program Administrator shall
reimburse the costs of monitoring and the costs of an initial health evaluation
provided under this title at a rate set by the Administrator by
regulation.

(3)

Determination of
medical necessity

(A)

Review of
medical necessity and protocols

As part of the process for
reimbursement or payment under this subsection, the WTC Program Administrator
shall provide for the review of claims for reimbursement or payment for the
provision of medical treatment to determine if such treatment is medically
necessary and in accordance with medical treatment protocols established under
subsection (d).

(B)

Withholding of
payment for medically unnecessary treatment

The Administrator
shall withhold such reimbursement or payment for treatment that the
Administrator determines is not medically necessary or is not in accordance
with such medical treatment protocols.

(d)

Medical
Treatment Protocols

(1)

Development

The Data Centers shall develop medical
treatment protocols for the treatment of enrolled WTC responders and
certified-eligible WTC survivors for health conditions included in the
applicable list of WTC-related health conditions.

(2)

Approval

The
medical treatment protocols developed under paragraph (1) shall be subject to
approval by the WTC Program Administrator.

3313.

National
arrangement for benefits for eligible individuals outside New York

(a)

In
general

In order to ensure
reasonable access to benefits under this subtitle for individuals who are
enrolled WTC responders, screening-eligible WTC survivors, or
certified-eligible WTC survivors and who reside in any State, as defined in
section 2(f), outside the New York metropolitan area, the WTC Program
Administrator shall establish a nationwide network of health care providers to
provide monitoring and treatment benefits and initial health evaluations near
such individuals’ areas of residence in such States. Nothing in this subsection
shall be construed as preventing such individuals from being provided such
monitoring and treatment benefits or initial health evaluation through any
Clinical Center of Excellence.

(b)

Network
requirements

Any health care provider participating in the
network under subsection (a) shall—

(1)

meet criteria for
credentialing established by the Data Centers;

(2)

follow the
monitoring, initial health evaluation, and treatment protocols developed under
section 3305(a)(2)(A)(ii);

(3)

collect and report
data in accordance with section 3304; and

(4)

meet such fraud,
quality assurance, and other requirements as the WTC Program Administrator
establishes, including sections 1128 through 1128E of the Social Security Act,
as applied by section 3301(d).

(c)

Training and
technical assistance

The WTC Program Administer may provide,
including through contract, for the provision of training and technical
assistance to health care providers participating in the network under
subsection (a).

In
this title, the term screening-eligible WTC survivor means,
subject to subparagraph (C) and paragraph (3), an individual who is described
in any of the following clauses:

(i)

Currently
identified survivor

An
individual, including a WTC responder, who has been identified as eligible for
medical treatment and monitoring by the WTC Environmental Health Center as of
the date of enactment of this title.

(ii)

Survivor who
meets current eligibility criteria

An individual who is not a WTC responder,
for purposes of the initial health evaluation under subsection (b), claims
symptoms of a WTC-related health condition and meets any of the current
eligibility criteria described in subparagraph (B).

(iii)

Survivor who
meets modified eligibility criteria

An individual who is not a WTC responder,
for purposes of the initial health evaluation under subsection (b), claims
symptoms of a WTC-related health condition and meets such eligibility criteria
relating to exposure to airborne toxins, other hazards, or adverse conditions
resulting from the September 11, 2001, terrorist attacks as the WTC
Administrator determines, after consultation with the Data Centers described in
section 3305 and the WTC Scientific/Technical Advisory Committee and WTC Health
Program Steering Committees under section 3302.

The
Administrator shall not modify such criteria under clause (iii) on or after the
date that the number of certifications for certified-eligible WTC survivors
under paragraph (2)(B) has reached 80 percent of the limit described in
paragraph (3) or on or after the date that the number of enrollments of WTC
responders has reached 80 percent of the limit described in section
3311(a)(4).(B)

Current
eligibility criteria

The eligibility criteria described in this
subparagraph for an individual are that the individual is described in any of
the following clauses:

(i)

A
person who was present in the New York City disaster area in the dust or dust
cloud on September 11, 2001.

(ii)

A
person who worked, resided, or attended school, childcare, or adult daycare in
the New York City disaster area for—

(I)

at least 4 days
during the 4-month period beginning on September 11, 2001, and ending on
January 10, 2002; or

(II)

at least 30 days
during the period beginning on September 11, 2001, and ending on July 31,
2002.

(iii)

Any person who
worked as a cleanup worker or performed maintenance work in the New York City
disaster area during the 4-month period described in subparagraph (B)(i) and
had extensive exposure to WTC dust as a result of such work.

(iv)

A
person who was deemed eligible to receive a grant from the Lower Manhattan
Development Corporation Residential Grant Program, who possessed a lease for a
residence or purchased a residence in the New York City disaster area, and who
resided in such residence during the period beginning on September 11, 2001,
and ending on May 31, 2003.

(v)

A
person whose place of employment—

(I)

at any time during
the period beginning on September 11, 2001, and ending on May 31, 2003, was in
the New York City disaster area; and

(II)

was deemed
eligible to receive a grant from the Lower Manhattan Development Corporation
WTC Small Firms Attraction and Retention Act program or other government
incentive program designed to revitalize the lower Manhattan economy after the
September 11, 2001, terrorist attacks.

(C)

Application and
determination process for screening eligibility

(i)

In
general

The WTC Program Administrator in consultation with the
Data Centers shall establish a process for individuals, other than individuals
described in subparagraph (A)(i), to be determined to be screening-eligible WTC
survivors. Under such process—

(I)

there shall be no
fee charged to the applicant for making an application for such
determination;

(II)

the Administrator shall make a
determination on such an application not later than 60 days after the date of
filing the application;

(III)

the Administrator shall make such a
determination relating to an applicant’s compliance with this title and shall
not determine that an individual is not so eligible or deny written
documentation under clause (ii) to such individual unless the Administrator
determines that—

(aa)

based on the
application submitted, the individual does not meet the eligibility criteria;
or

(bb)

the numerical limitation on certifications
of certified-eligible WTC survivors set forth in paragraph (3) has been met;
and

(IV)

an individual who is determined not to be a
screening-eligible WTC survivor shall have an opportunity to appeal such
determination in a manner established under such process.

(ii)

Written
documentation of screening-eligibility

(I)

In
general

In the case of an individual who is described in
subparagraph (A)(i) or who is determined under clause (i) (consistent with
paragraph (3)) to be a screening-eligible WTC survivor, the WTC Program
Administrator shall provide an appropriate written documentation of such
fact.

(II)

Timing

(aa)

Currently
identified survivors

In the case of an individual who is
described in subparagraph (A)(i), the WTC Program Administrator shall provide
the written documentation under subclause (I) not later than July 1,
2011.

(bb)

Other
members

In the case of another individual who is determined under
clause (i) and consistent with paragraph (3) to be a screening-eligible WTC
survivor, the WTC Program Administrator shall provide the written documentation
under subclause (I) at the time of such determination.

(2)

Certified-eligible
WTC survivors

(A)

Definition

The term certified-eligible WTC
survivor means, subject to paragraph (3), a screening-eligible WTC
survivor who the WTC Program Administrator certifies under subparagraph (B) to
be eligible for followup monitoring and treatment under this part.

(B)

Certification of
eligibility for monitoring and treatment

(i)

In
general

The WTC Program
Administrator shall establish a certification process under which the
Administrator shall provide appropriate certification to screening-eligible WTC
survivors who, pursuant to the initial health evaluation under subsection (b),
are determined to be eligible for followup monitoring and treatment under this
part.

(ii)

Timing

(I)

Currently
identified survivors

In the case of an individual who is
described in paragraph (1)(A)(i), the WTC Program Administrator shall provide
the certification under clause (i) not later than July 1, 2011.

(II)

Other
members

In the case of another individual who is determined under
clause (i) to be eligible for followup monitoring and treatment, the WTC
Program Administrator shall provide the certification under such clause at the
time of such determination.

(3)

Numerical
limitation on certified-eligible WTC survivors

(A)

In
general

The total number of
individuals not described in paragraph (1)(A)(i) who may be certified as
certified-eligible WTC survivors under paragraph (2)(B) shall not exceed 25,000
at any time.

(B)

Process

In
implementing subparagraph (A), the WTC Program Administrator shall—

(i)

limit the number
of certifications provided under paragraph (2)(B)—

(I)

in accordance with
such subparagraph; and

(II)

to such number, as determined by the
Administrator based on the best available information and subject to amounts
made available under section 3351, that will ensure sufficient funds will be
available to provide treatment and monitoring benefits under this title, with
respect to all individuals receiving such certifications through the end of
fiscal year 2020; and

(ii)

provide priority
in such certifications in the order in which individuals apply for a
determination under paragraph (2)(B).

(4)

Disqualification
of individuals on terrorist watch list

No individual who is on the terrorist watch
list maintained by the Department of Homeland Security shall qualify as a
screening-eligible WTC survivor or a certified-eligible WTC survivor. Before
determining any individual to be a screening-eligible WTC survivor under
paragraph (1) or certifying any individual as a certified eligible WTC survivor
under paragraph (2), the Administrator, in consultation with the Secretary of
Homeland Security, shall determine whether the individual is on such
list.

In the case of a
screening-eligible WTC survivor, the WTC Program shall provide for an initial
health evaluation to determine if the survivor has a WTC-related health
condition and is eligible for followup monitoring and treatment benefits under
the WTC Program. Initial health evaluation protocols under section
3305(a)(2)(A)(ii) shall be subject to approval by the WTC Program
Administrator.

(2)

Initial health
evaluation providers

The
initial health evaluation described in paragraph (1) shall be provided through
a Clinical Center of Excellence with respect to the individual involved.

(3)

Limitation on
initial health evaluation benefits

Benefits for an initial health evaluation
under this part for a screening-eligible WTC survivor shall consist only of a
single medical initial health evaluation consistent with initial health
evaluation protocols described in paragraph (1). Nothing in this paragraph
shall be construed as preventing such an individual from seeking additional
medical initial health evaluations at the expense of the individual.

Subject to subsection
(b), the provisions of sections 3311 and 3312 shall apply to followup
monitoring and treatment of WTC-related health conditions for
certified-eligible WTC survivors in the same manner as such provisions apply to
the monitoring and treatment of WTC-related health conditions for enrolled WTC
responders.

(b)

List of
WTC-Related health conditions for survivors

The list of health conditions for
screening-eligible WTC survivors and certified-eligible WTC survivors consists
of the following:

(1)

Aerodigestive
disorders

(A)

Interstitial lung
diseases.

(B)

Chronic
respiratory disorder—fumes/vapors.

(C)

Asthma.

(D)

Reactive airways
dysfunction syndrome (RADS).

(E)

WTC-exacerbated
chronic obstructive pulmonary disease (COPD).

(F)

Chronic cough
syndrome.

(G)

Upper airway
hyperreactivity.

(H)

Chronic
rhinosinusitis.

(I)

Chronic
nasopharyngitis.

(J)

Chronic
laryngitis.

(K)

Gastroesophageal
reflux disorder (GERD).

(L)

Sleep apnea
exacerbated by or related to a condition described in a previous clause.

(2)

Mental health
conditions

(A)

Posttraumatic
stress disorder (PTSD).

(B)

Major depressive
disorder.

(C)

Panic
disorder.

(D)

Generalized
anxiety disorder.

(E)

Anxiety disorder
(not otherwise specified).

(F)

Depression (not
otherwise specified).

(G)

Acute stress
disorder.

(H)

Dysthymic
disorder.

(I)

Adjustment
disorder.

(J)

Substance
abuse.

(3)

Additional
conditions

Any cancer (or
type of cancer) or other condition added to the list in section 3312(a)(3)
pursuant to paragraph (5) or (6) of section 3312(a), as such provisions are
applied under subsection (a) with respect to certified-eligible WTC
survivors.

3323.

Followup
monitoring and treatment of other individuals with WTC-related health
conditions

(a)

In
General

Subject to subsection
(c), the provisions of section 3322 shall apply to the followup monitoring and
treatment of WTC-related health conditions in the case of individuals described
in subsection (b) in the same manner as such provisions apply to the followup
monitoring and treatment of WTC-related health conditions for
certified-eligible WTC survivors.

(b)

Individuals
described

An individual described in this subsection is an
individual who, regardless of location of residence—

(1)

is not an enrolled WTC responder or a
certified-eligible WTC survivor; and

(2)

is diagnosed at a Clinical Center of
Excellence with a WTC-related health condition for certified-eligible WTC
survivors.

(c)

Limitation

(1)

In
general

The WTC Program Administrator shall limit benefits for
any fiscal year under subsection (a) in a manner so that payments under this
section for such fiscal year do not exceed the amount specified in paragraph
(2) for such fiscal year.

(2)

Limitation

The
amount specified in this paragraph for—

(A)

the last calendar
quarter of fiscal year 2011 is $5,000,000;

(B)

fiscal year 2012
is $20,000,000; or

(C)

a succeeding fiscal year is the amount
specified in this paragraph for the previous fiscal year increased by the
annual percentage increase in the medical care component of the consumer price
index for all urban consumers.

3

Payor
provisions

3331.

Payment of
claims

(a)

In
general

Except as provided in
subsections (b) and (c), the cost of monitoring and treatment benefits and
initial health evaluation benefits provided under parts 1 and 2 of this
subtitle shall be paid for by the WTC Program from the World Trade Center
Health Program Fund.

(b)

Workers’
compensation payment

(1)

In
general

Subject to paragraph (2), payment for treatment under
parts 1 and 2 of this subtitle of a WTC-related health condition of an
individual that is work-related shall be reduced or recouped to the extent that
the WTC Program Administrator determines that payment has been made, or can
reasonably be expected to be made, under a workers’ compensation law or plan of
the United States, a State, or a locality, or other work-related injury or
illness benefit plan of the employer of such individual, for such treatment.
The provisions of clauses (iii), (iv), (v), and (vi) of paragraph (2)(B) of
section 1862(b) of the Social Security Act and paragraphs (3) and (4) of such
section shall apply to the recoupment under this subsection of a payment to the
WTC Program (with respect to a workers’ compensation law or plan, or other
work-related injury or illness plan of the employer involved, and such
individual) in the same manner as such provisions apply to the reimbursement of
a payment under section 1862(b)(2) of such Act to the Secretary (with respect
to such a law or plan and an individual entitled to benefits under title XVIII
of such Act) except that any reference in such paragraph (4) to payment rates
under title XVIII of the Social Security Act shall be deemed a reference to
payment rates under this title.

(2)

Exception

Paragraph (1) shall not apply for any
quarter, with respect to any workers’ compensation law or plan, including line
of duty compensation, to which New York City is obligated to make payments, if,
in accordance with terms specified under the contract under subsection
(d)(1)(A), New York City has made the full payment required under such contract
for such quarter.

(3)

Rules of
construction

Nothing in this title shall be construed to affect,
modify, or relieve any obligations under a worker’s compensation law or plan,
other work-related injury or illness benefit plan of an employer, or any health
insurance plan.

(c)

Health insurance
coverage

(1)

In
general

In the case of an
individual who has a WTC-related health condition that is not work-related and
has health coverage for such condition through any public or private health
plan (including health benefits under title XVIII, XIX, or XXI of the Social
Security Act) the provisions of section 1862(b) of the Social Security Act
shall apply to such a health plan and such individual in the same manner as
they apply to group health plan and an individual entitled to benefits under
title XVIII of such Act pursuant to section 226(a) of such Act. Any costs for
items and services covered under such plan that are not reimbursed by such
health plan, due to the application of deductibles, copayments, coinsurance,
other cost sharing, or otherwise, are reimbursable under this title to the
extent that they are covered under the WTC Program. The program under this
title shall not be treated as a legally liable party for purposes of applying
section 1902(a)(25) of the Social Security Act.

(2)

Recovery by
individual providers

Nothing in paragraph (1) shall be construed
as requiring an entity providing monitoring and treatment under this title to
seek reimbursement under a health plan with which the entity has no contract
for reimbursement.

(3)

Maintenance of
required minimum essential coverage

No payment may be made for monitoring and
treatment under this title for an individual for a month (beginning with July
2014) if with respect to such month the individual—

(A)

is an applicable
individual (as defined in subsection (d) of section 5000A of Internal Revenue
Code of 1986) for whom the exemption under subsection (e) of such section does
not apply; and

(B)

is not covered
under minimum essential coverage, as required under subsection (a) of such
section.

(d)

Required
contribution by New York City in program costs

(1)

Contract
requirement

(A)

In
general

No funds may be
disbursed from the World Trade Center Health Program Fund under section 3351
unless New York City has entered into a contract with the WTC Program
Administrator under which New York City agrees, in a form and manner specified
by the Administrator, to pay the full contribution described in subparagraph
(B) in accordance with this subsection on a timely basis, plus any interest
owed pursuant to subparagraph (E)(i). Such contract shall specify the terms
under which New York City shall be considered to have made the full payment
required for a quarter for purposes of subsection (b)(2).

(B)

Full
contribution amount

Under
such contract, with respect to the last calendar quarter of fiscal year 2011
and each calendar quarter in fiscal years 2012 through 2018 the full
contribution amount under this subparagraph shall be equal to 10 percent of the
expenditures in carrying out this title for the respective quarter and with
respect to calendar quarters in fiscal years 2019 and 2020, such full
contribution amount shall be equal to 1/9 of the Federal
expenditures in carrying out this title for the respective quarter.

(C)

Satisfaction of
payment obligation

The payment obligation under such contract may
not be satisfied through any of the following:

(i)

An
amount derived from Federal sources.

(ii)

An amount paid
before the date of the enactment of this title.

(iii)

An amount paid
to satisfy a judgment or as part of a settlement related to injuries or
illnesses arising out of the September 11, 2001, terrorist attacks.

(D)

Timing of
contribution

The payment
obligation under such contract for a calendar quarter in a fiscal year shall be
paid not later than the last day of the second succeeding calendar
quarter.

(E)

Compliance

(i)

Interest for
late payment

If New York City fails to pay to the WTC Program
Administrator pursuant to such contract the amount required for any calendar
quarter by the day specified in subparagraph (D), interest shall accrue on the
amount not so paid at the rate (determined by the Administrator) based on the
average yield to maturity, plus 1 percentage point, on outstanding municipal
bonds issued by New York City with a remaining maturity of at least 1
year.

(ii)

Recovery of
amounts owed

The amounts owed to the WTC Program Administrator
under such contract shall be recoverable by the United States in an action in
the same manner as payments made under title XVIII of the Social Security Act
may be recoverable in an action brought under section 1862(b)(2)(B)(iii) of
such Act.

(F)

Deposit in
Fund

The WTC Program Administer shall deposit amounts paid under
such contract into the World Trade Center Health Program Fund under section
3351.

(2)

Payment of New
York City share of monitoring and treatment costs

With respect to each calendar quarter for
which a contribution is required by New York City under the contract under
paragraph (1), the WTC Program Administrator shall—

(A)

provide New York
City with an estimate of such amount of the required contribution at the
beginning of such quarter and with an updated estimate of such amount at the
beginning of each of the subsequent 2 quarters;

(B)

bill such amount
directly to New York City; and

(C)

certify
periodically, for purposes of this subsection, whether or not New York City has
paid the amount so billed.

Such amount shall initially be
estimated by the WTC Program Administrator and shall be subject to adjustment
and reconciliation based upon actual expenditures in carrying out this
title.(3)

Rule of
construction

Nothing in this subsection shall be construed as
authorizing the WTC Administrator, with respect to a fiscal year, to reduce the
numerical limitation under section 3311(a)(4) or 3321(a)(3) for such fiscal
year if New York City fails to comply with paragraph (1) for a calendar quarter
in such fiscal year.

(e)

Work-Related
described

For the purposes of
this section, a WTC-related health condition shall be treated as a condition
that is work-related if—

(1)

the condition is diagnosed in an enrolled
WTC responder, or in an individual who qualifies as a certified-eligible WTC
survivor on the basis of being a rescue, recovery, or cleanup worker; or

(2)

with respect to the condition the
individual has filed and had established a claim under a workers’ compensation
law or plan of the United States or a State, or other work-related injury or
illness benefit plan of the employer of such individual.

3332.

Administrative
arrangement authority

The WTC
Program Administrator may enter into arrangements with other government
agencies, insurance companies, or other third-party administrators to provide
for timely and accurate processing of claims under sections 3312, 3313, 3322,
and 3323.

With respect to
individuals, including enrolled WTC responders and certified-eligible WTC
survivors, receiving monitoring or treatment under subtitle B, the WTC Program
Administrator shall conduct or support—

(1)

research on
physical and mental health conditions that may be related to the September 11,
2001, terrorist attacks;

(2)

research on
diagnosing WTC-related health conditions of such individuals, in the case of
conditions for which there has been diagnostic uncertainty; and

(3)

research on
treating WTC-related health conditions of such individuals, in the case of
conditions for which there has been treatment uncertainty.

The
Administrator may provide such support through continuation and expansion of
research that was initiated before the date of the enactment of this title and
through the World Trade Center Health Registry (referred to in section 3342),
through a Clinical Center of Excellence, or through a Data Center.(b)

Types of
research

The research under
subsection (a)(1) shall include epidemiologic and other research studies on
WTC-related health conditions or emerging conditions—

(1)

among enrolled WTC
responders and certified-eligible WTC survivors under treatment; and

(2)

in sampled
populations outside the New York City disaster area in Manhattan as far north
as 14th Street and in Brooklyn, along with control populations, to identify
potential for long-term adverse health effects in less exposed
populations.

(c)

Consultation

The WTC Program Administrator shall carry
out this section in consultation with the WTC Scientific/Technical Advisory
Committee.

(d)

Application of
Privacy and Human Subject Protections

The privacy and human
subject protections applicable to research conducted under this section shall
not be less than such protections applicable to research conducted or funded by
the Department of Health and Human Services.

3342.

World Trade
Center Health Registry

For the
purpose of ensuring ongoing data collection relating to victims of the
September 11, 2001, terrorist attacks, the WTC Program Administrator shall
ensure that a registry of such victims is maintained that is at least as
comprehensive as the World Trade Center Health Registry maintained under the
arrangements in effect as of April 20, 2009, with the New York City Department
of Health and Mental Hygiene.

D

Funding

3351.

World Trade
Center Health Program Fund

(a)

Establishment of
Fund

(1)

In
general

There is established
a fund to be known as the World Trade Center Health Program Fund (referred to
in this section as the Fund).

(2)

Funding

Out of any money in the Treasury not
otherwise appropriated, there shall be deposited into the Fund for each of
fiscal years 2012 through 2020 (and the last calendar quarter of fiscal year
2011)—

(A)

the Federal share, consisting of an amount
equal to the lesser of—

(i)

90 percent of the expenditures in carrying
out this title for the respective fiscal year (initially based on estimates,
subject to subsequent reconciliation based on actual expenditures); or

(ii)(I)

$71,000,000 for the last
calendar quarter of fiscal year 2011, $318,000,000 for fiscal year 2012,
$354,000,000 for fiscal year 2013, $382,000,000 for fiscal year 2014,
$431,000,000 for fiscal year 2015, $481,000,000 for fiscal year 2016,
$537,000,000 for fiscal year 2017, $601,000,000 for fiscal year 2018, and
$173,000,000 for fiscal year 2019; and

(II)

subject to paragraph (4), an additional
$499,000,000 for fiscal year 2019 and $743,000,000 for fiscal year 2020;
plus

(B)

the New York City
share, consisting of the amount contributed under the contract under section
3331(d).

(3)

Contract
requirement

(A)

In
general

No funds may be
disbursed from the Fund unless New York City has entered into a contract with
the WTC Program Administrator under section 3331(d)(1).

(B)

Breach of
contract

In the case of a failure to pay the amount so required
under the contract—

(i)

the amount is
recoverable under subparagraph (E)(ii) of such section;

(ii)

such failure shall not affect the
disbursement of amounts from the Fund; and

(iii)

the Federal
share described in paragraph (2)(A) shall not be increased by the amount so
unpaid.

(4)

Aggregate
limitation on funding beginning with fiscal year 2019

Beginning with fiscal year 2019, in no case
shall the share of Federal funds deposited into the Fund under paragraph (2)
for such fiscal year and previous fiscal years and quarters exceed the sum of
the amounts specified in paragraph (2)(A)(ii)(I).

The amounts deposited
into the Fund under subsection (a)(2) shall be available, without further
appropriation, consistent with paragraph (2) and subsection (c), to carry out
subtitle B and sections 3302(a), 3303, 3304, 3305(a)(2), 3305(c), 3341, and
3342.

(2)

Limitation on
mandatory funding

This title
does not establish any Federal obligation for payment of amounts in excess of
the amounts available from the Fund for such purpose.

(3)

Limitation on
authorization for further appropriations

This title does not establish any
authorization for appropriation of amounts in excess of the amounts available
from the Fund under paragraph (1).

(c)

Limits on
Spending for Certain Purposes

Of the amounts made available under
subsection (b)(1), not more than each of the following amounts may be available
for each of the following purposes:

(1)

Surviving
immediate family members of firefighters

For the purposes of carrying out subtitle B
with respect to WTC responders described in section 3311(a)(2)(A)(ii)—

(A)

for the last
calendar quarter of fiscal year 2011, $100,000;

(B)

for fiscal year
2012, $400,000; and

(C)

for each subsequent fiscal year, the amount
specified under this paragraph for the previous fiscal year increased by the
percentage increase in the consumer price index for all urban consumers (all
items; United States city average) as estimated by the Secretary for the
12-month period ending with March of the previous year.

(2)

WTC Health
Program Scientific/Technical Advisory Committee

For the purpose
of carrying out section 3302(a)—

(A)

for the last
calendar quarter of fiscal year 2011, $25,000;

(B)

for fiscal year
2012, $100,000; and

(C)

for each
subsequent fiscal year, the amount specified under this paragraph for the
previous fiscal year increased by the percentage increase in the consumer price
index for all urban consumers (all items; United States city average) as
estimated by the Secretary for the 12-month period ending with March of the
previous year.

(3)

Education and
outreach

For the purpose of carrying out section 3303—

(A)

for the last calendar quarter of fiscal
year 2011, $500,000;

(B)

for fiscal year
2012, $2,000,000; and

(C)

for each
subsequent fiscal year, the amount specified under this paragraph for the
previous fiscal year increased by the percentage increase in the consumer price
index for all urban consumers (all items; United States city average) as
estimated by the Secretary for the 12-month period ending with March of the
previous year.

(4)

Uniform data
collection

For the purpose of carrying out section 3304 and for
reimbursing Data Centers (as defined in section 3305(b)(2)) for the costs
incurred by such Centers in carrying out activities under contracts entered
into under section 3305(a)(2)—

(A)

for the last calendar quarter of fiscal
year 2011, $2,500,000;

(B)

for fiscal year
2012, $10,000,000; and

(C)

for each
subsequent fiscal year, the amount specified under this paragraph for the
previous fiscal year increased by the percentage increase in the consumer price
index for all urban consumers (all items; United States city average) as
estimated by the Secretary for the 12-month period ending with March of the
previous year.

(5)

Research
regarding certain health conditions

For the purpose of carrying
out section 3341—

(A)

for the last
calendar quarter of fiscal year 2011, $3,750,000;

(B)

for fiscal year
2012, $15,000,000; and

(C)

for each
subsequent fiscal year, the amount specified under this paragraph for the
previous fiscal year increased by the percentage increase in the consumer price
index for all urban consumers (all items; United States city average) as
estimated by the Secretary for the 12-month period ending with March of the
previous year.

(6)

World Trade
Center Health Registry

For
the purpose of carrying out section 3342—

(A)

for the last calendar quarter of fiscal
year 2011, $1,750,000;

(B)

for fiscal year
2012, $7,000,000; and

(C)

for each
subsequent fiscal year, the amount specified under this paragraph for the
previous fiscal year increased by the percentage increase in the consumer price
index for all urban consumers (all items; United States city average) as
estimated by the Secretary for the 12-month period ending with March of the
previous
year.

.

II

September 11th
Victim Compensation Fund of 2001

201.

Definitions

Section 402 of the Air Transportation Safety
and System Stabilization Act (49 U.S.C. 40101 note) is
amended—

(1)

in paragraph (6)
by inserting , or debris removal, including under the World Trade Center
Health Program established under section 3001 of the Public Health Service Act,
and payments made pursuant to the settlement of a civil action described in
section 405(c)(3)(C)(iii) after September 11,
2001;

(2)

by inserting after
paragraph (6) the following new paragraphs and redesignating subsequent
paragraphs accordingly:

(7)

Contractor and
subcontractor

The term
contractor and subcontractor means any contractor or subcontractor
(at any tier of a subcontracting relationship), including any general
contractor, construction manager, prime contractor, consultant, or any parent,
subsidiary, associated or allied company, affiliated company, corporation,
firm, organization, or joint venture thereof that participated in debris
removal at any 9/11 crash site. Such term shall not include any entity,
including the Port Authority of New York and New Jersey, with a property
interest in the World Trade Center, on September 11, 2001, whether fee simple,
leasehold or easement, direct or indirect.

(8)

Debris
removal

The term debris
removal means rescue and recovery efforts, removal of debris, cleanup,
remediation, and response during the immediate aftermath of the
terrorist-related aircraft crashes of September 11, 2001, with respect to a
9/11 crash
site.

;

(3)

by inserting after
paragraph (10), as so redesignated, the following new paragraph and
redesignating the subsequent paragraphs accordingly:

(11)

Immediate
aftermath

The term
immediate aftermath means any period beginning with the
terrorist-related aircraft crashes of September 11, 2001, and ending on August
30, 2002.

the buildings or
portions of buildings that were destroyed as a result of the terrorist-related
aircraft crashes of September 11, 2001;

(C)

any area
contiguous to a site of such crashes that the Special Master determines was
sufficiently close to the site that there was a demonstrable risk of physical
harm resulting from the impact of the aircraft or any subsequent fire,
explosions, or building collapses (including the immediate area in which the
impact occurred, fire occurred, portions of buildings fell, or debris fell upon
and injured individuals); and

(D)

any area related to, or along, routes of
debris removal, such as barges and Fresh
Kills.

.

202.

Extended and
expanded eligibility for compensation

(a)

Information on
losses resulting from debris removal included in contents of claim
form

Section 405(a)(2)(B) of
the Air Transportation Safety and System Stabilization Act (49 U.S.C. 40101
note) is amended—

(1)

in clause (i), by
inserting , or debris removal during the immediate aftermath
after September 11, 2001;

(2)

in clause (ii), by
inserting or debris removal during the immediate aftermath after
crashes; and

(3)

in clause (iii),
by inserting or debris removal during the immediate aftermath
after crashes.

(b)

Extension of
deadline for claims under September 11th Victim Compensation Fund of
2001

Section 405(a)(3) of
such Act is amended to read as follows:

(3)

Limitation

(A)

In
general

Except as provided by
subparagraph (B), no claim may be filed under paragraph (1) after the date that
is 2 years after the date on which regulations are promulgated under section
407(a).

(B)

Exception

A claim may be filed under paragraph (1),
in accordance with subsection (c)(3)(A)(i), by an individual (or by a personal
representative on behalf of a deceased individual) during the period beginning
on the date on which the regulations are updated under section 407(b) and
ending on December 22,
2031.

.

(c)

Requirements for
filing claims during extended filing period

Section 405(c)(3) of
such Act is amended—

(1)

by redesignating
subparagraphs (A) and (B) as subparagraphs (B) and (C), respectively;
and

(2)

by inserting
before subparagraph (B), as so redesignated, the following new
subparagraph:

(A)

Requirements for
filing claims during extended filing period

(i)

Timing
requirements for filing claims

An individual (or a personal
representative on behalf of a deceased individual) may file a claim during the
period described in subsection (a)(3)(B) as follows:

(I)

In the case that
the Special Master determines the individual knew (or reasonably should have
known) before the date specified in clause (iii) that the individual suffered a
physical harm at a 9/11 crash site as a result of the terrorist-related
aircraft crashes of September 11, 2001, or as a result of debris removal, and
that the individual knew (or should have known) before such specified date that
the individual was eligible to file a claim under this title, the individual
may file a claim not later than the date that is 2 years after such specified
date.

(II)

In the case that
the Special Master determines the individual first knew (or reasonably should
have known) on or after the date specified in clause (iii) that the individual
suffered such a physical harm or that the individual first knew (or should have
known) on or after such specified date that the individual was eligible to file
a claim under this title, the individual may file a claim not later than the
last day of the 2-year period beginning on the date the Special Master
determines the individual first knew (or should have known) that the individual
both suffered from such harm and was eligible to file a claim under this
title.

(ii)

Other
eligibility requirements for filing claims

An individual may file
a claim during the period described in subsection (a)(3)(B) only if—

(I)

the individual was
treated by a medical professional for suffering from a physical harm described
in clause (i)(I) within a reasonable time from the date of discovering such
harm; and

(II)

the individual’s
physical harm is verified by contemporaneous medical records created by or at
the direction of the medical professional who provided the medical care.

(iii)

Date
specified

The date specified in this clause is the date on which
the regulations are updated under section
407(a).

.

(d)

Clarifying
applicability to all 9/11 crash sites

Section 405(c)(2)(A)(i) of
such Act is amended by striking or the site of the aircraft crash at
Shanksville, Pennsylvania and inserting the site of the aircraft
crash at Shanksville, Pennsylvania, or any other 9/11 crash
site.

(e)

Inclusion of
physical harm resulting from debris removal

Section 405(c) of such Act is amended in
paragraph (2)(A)(ii), by inserting or debris removal after
air crash.

(f)

Limitations on
civil actions

(1)

Application to
damages related to debris removal

Clause (i) of section
405(c)(3)(C) of such Act, as redesignated by subsection (c), is amended by
inserting , or for damages arising from or related to debris
removal after September 11, 2001.

(2)

Pending
actions

Clause (ii) of such section, as so redesignated, is
amended to read as follows:

(ii)

Pending
actions

In the case of an
individual who is a party to a civil action described in clause (i), such
individual may not submit a claim under this title—

(I)

during the period
described in subsection (a)(3)(A) unless such individual withdraws from such
action by the date that is 90 days after the date on which regulations are
promulgated under section 407(a); and

(II)

during the period
described in subsection (a)(3)(B) unless such individual withdraws from such
action by the date that is 90 days after the date on which the regulations are
updated under section
407(b).

.

(3)

Settled actions;
authority to reinstitute certain lawsuits

Such section, as so
redesignated, is further amended by adding at the end the following new
clauses:

(iii)

Settled
actions

In the case of an
individual who settled a civil action described in clause (i), such individual
may not submit a claim under this title unless such action was commenced after
December 22, 2003, and a release of all claims in such action was tendered
prior to the date on which the James Zadroga 9/11 Health and Compensation Act
of 2010 was enacted.

(iv)

Authority to
reinstitute certain lawsuits

In the case of a claimant who was a party
to a civil action described in clause (i), who withdrew from such action
pursuant to clause (ii), and who is subsequently determined to not be an
eligible individual for purposes of this subsection, such claimant may
reinstitute such action without prejudice during the 90-day period beginning
after the date of such ineligibility
determination.

.

203.

Requirement to
update regulations

Section 407
of the Air Transportation Safety and System Stabilization Act (49 U.S.C. 40101
note) is amended—

(1)

by striking
Not later than and inserting (a) In
general.—Not later than; and

(2)

by adding at the
end the following new subsection:

(b)

Updated
regulations

Not later than 90
days after the date of the enactment of the James Zadroga 9/11 Health and
Compensation Act of 2010, the Special Master shall update the regulations
promulgated under subsection (a) to the extent necessary to comply with the
provisions of title II of such
Act.

.

204.

Limited
liability for certain claims

Section 408(a) of the Air Transportation
Safety and System Stabilization Act (49 U.S.C. 40101 note) is amended
by adding at the end the following new paragraphs:

(4)

Liability for
certain claims

Notwithstanding any other provision of law,
liability for all claims and actions (including claims or actions that have
been previously resolved, that are currently pending, and that may be filed
through December 22, 2031) for compensatory damages, contribution or indemnity,
or any other form or type of relief, arising from or related to debris removal,
against the City of New York, any entity (including the Port Authority of New
York and New Jersey) with a property interest in the World Trade Center on
September 11, 2001 (whether fee simple, leasehold or easement, or direct or
indirect) and any contractors and subcontractors, shall not be in an amount
that exceeds the sum of the following, as may be applicable:

(A)

The amount of
funds of the WTC Captive Insurance Company, including the cumulative
interest.

(B)

The amount of all
available insurance identified in schedule 2 of the WTC Captive Insurance
Company insurance policy.

(C)

As it relates to the limitation of
liability of the City of New York, the amount that is the greater of the City
of New York’s insurance coverage or $350,000,000. In determining the amount of
the City’s insurance coverage for purposes of the previous sentence, any amount
described in clauses (i) and (ii) shall not be included.

(D)

As it relates to
the limitation of liability of any entity, including the Port Authority of New
York and New Jersey, with a property interest in the World Trade Center on
September 11, 2001 (whether fee simple, leasehold or easement, or direct or
indirect), the amount of all available liability insurance coverage maintained
by any such entity.

(E)

As it relates to the limitation of
liability of any individual contractor or subcontractor, the amount of all
available liability insurance coverage maintained by such contractor or
subcontractor on September 11, 2001.

(5)

Priority of
claims payments

Payments to
plaintiffs who obtain a settlement or judgment with respect to a claim or
action to which paragraph (4)(A) applies, shall be paid solely from the
following funds in the following order, as may be applicable:

(A)

The funds
described in clause (i) or (ii) of paragraph (4)(A).

(B)

If there are no
funds available as described in clause (i) or (ii) of paragraph (4)(A), the
funds described in clause (iii) of such paragraph.

(C)

If there are no funds available as
described in clause (i), (ii), or (iii) of paragraph (4)(A), the funds
described in clause (iv) of such paragraph.

(D)

If there are no funds available as
described in clause (i), (ii), (iii), or (iv) of paragraph (4)(A), the funds
described in clause (v) of such paragraph.

(6)

Declaratory
judgment actions and direct action

Any party to a claim or action to which
paragraph (4)(A) applies may, with respect to such claim or action, either file
an action for a declaratory judgment for insurance coverage or bring a direct
action against the insurance company
involved.

.

205.

Funding;
attorney fees

Section 406 of
the Air Transportation Safety and System Stabilization Act (49 U.S.C. 40101
note) is amended—

(1)

in subsection (a), by striking Not
later than and inserting Subject to the limitations under
subsection (d), not later than;

(2)

in subsection
(b)—

(A)

by inserting
in the amounts provided under subsection (d)(1) after
appropriations Acts; and

(B)

by inserting
subject to the limitations under subsection (d) before the
period; and

(3)

by adding at the
end the following new subsections:

(d)

Limitation

(1)

In
general

The total amount of
Federal funds paid for compensation under this title, with respect to claims
filed on or after the date on which the regulations are updated under section
407(b), shall not exceed $8,400,000,000. Of such amounts, $4,200,000,000 shall
be available to pay such claims during the 10-year period beginning on such
date and $4,200,000,000 shall be available to pay such claims after such
period.

(2)

Pro-ration and
payment of remaining claims

(A)

In
general

With respect to the one-year period beginning on the date
on which the first payment is made under this title for claims filed pursuant
to the regulations updated under section 407(b), the Special Master shall
examine the total number of such claims paid during such period and the amounts
of the payments made for such claims to project the total number and amount of
claims expected to be paid under this title during the 10-year period described
in paragraph (1). If, based on such projection, the Special Master determines
that there will be insufficient funds available under paragraph (1) to pay such
claims during such 10-year period, beginning on the first day following such
one-year period, the Special Master shall ratably reduce the amount of
compensation due claimants under this title in a manner to ensure, to the
extent possible, that—

(i)

all claimants who,
before application of the limitation under the second sentence of paragraph
(1), would have been determined to be entitled to a payment under this title
during such 10-year period, receive a payment during such period; and

(ii)

the total amount
of all such payments made during such 10-year period do not exceed the amount
available under the second sentence of paragraph (1) to pay claims during such
period.

(B)

Payment of
remainder of claim amounts

In any case in which the amount of a
claim is ratably reduced pursuant to subparagraph (A), on or after the first
day after the 10-year period described in paragraph (1), the Special Master
shall pay to the claimant the amount that is equal to the difference
between—

(i)

the amount that
the claimant would have been paid under this title during such period without
regard to the limitation under the second sentence of paragraph (1) applicable
to such period; and

(ii)

the amount the
claimant was paid under this title during such period.

(e)

Attorney
fees

(1)

In
general

Notwithstanding any
contract, and except as provided in paragraphs (2) and (3), the representative
of an individual may not charge, for services rendered in connection with the
claim of an individual under this title, more than 10 percent of an award made
under this title on such claim.

(2)

Limitation

(A)

In
general

Except as provided in subparagraph (B), in the case of an
individual who was charged a legal fee in connection with the settlement of a
civil action described in section 405(c)(3)(C)(iii), the representative of the
individual may not charge any amount for compensation for services rendered in
connection with a claim filed under this title.

(B)

Exception

If
the legal fee charged in connection with the settlement of a civil action
described in section 405(c)(3)(C)(iii) of an individual is less than 10 percent
of the aggregate amount of compensation awarded to such individual through such
settlement and the claim of the individual under this title, the representative
of such individual may charge an amount for compensation for services rendered
in connection with such claim under this title to the extent that such amount
charged is not more than—

(i)

10 percent of such
aggregate amount, minus

(ii)

the total amount
of all legal fees charged for services rendered in connection with such
settlement.

(3)

Exception

With respect to a claim made on behalf of
an individual for whom a lawsuit was filed in the Southern District of New York
prior to January 1, 2009, in the event that the representative believes in good
faith that the fee limit set by paragraph (1) or (2) will not provide adequate
compensation for services rendered in connection with such claim because of the
substantial amount of legal work provided on behalf of the claimant (including
work performed before the enactment of this legislation), application for
greater compensation may be made to the Special Master. Upon such application,
the Special Master may, in his or her discretion, award as reasonable
compensation for services rendered an amount greater than that allowed for in
paragraph (1). Such fee award will be final, binding, and
non-appealable.

.

III

Limitation on
Treaty Benefits for Certain Deductible Payments; Time for Payment of Corporate
Estimated Taxes

301.

Limitation on treaty
benefits for certain deductible payments

(a)

In
general

Section 894 of the Internal Revenue Code of 1986
(relating to income affected by treaty) is amended by adding at the end the
following new subsection:

(d)

Limitation on
treaty benefits for certain deductible payments

(1)

In
general

In the case of any
deductible related-party payment, any withholding tax imposed under chapter 3
(and any tax imposed under subpart A or B of this part) with respect to such
payment may not be reduced under any treaty of the United States unless any
such withholding tax would be reduced under a treaty of the United States if
such payment were made directly to the foreign parent corporation.

(2)

Deductible
related-party payment

For purposes of this subsection, the term
deductible related-party payment means any payment made, directly
or indirectly, by any person to any other person if the payment is allowable as
a deduction under this chapter and both persons are members of the same foreign
controlled group of entities.

(3)

Foreign
controlled group of entities

For purposes of this subsection—

(A)

In
general

The term
foreign controlled group of entities means a controlled group of
entities the common parent of which is a foreign corporation.

(B)

Controlled group
of entities

The term
controlled group of entities means a controlled group of
corporations as defined in section 1563(a)(1), except that—

(i)

more than
50 percent shall be substituted for at least 80 percent
each place it appears therein, and

(ii)

the determination
shall be made without regard to subsections (a)(4) and (b)(2) of section
1563.

A
partnership or any other entity (other than a corporation) shall be treated as
a member of a controlled group of entities if such entity is controlled (within
the meaning of section 954(d)(3)) by members of such group (including any
entity treated as a member of such group by reason of this sentence).(4)

Foreign parent
corporation

For purposes of this subsection, the term
foreign parent corporation means, with respect to any deductible
related-party payment, the common parent of the foreign controlled group of
entities referred to in paragraph (3)(A).

(5)

Regulations

The
Secretary may prescribe such regulations or other guidance as are necessary or
appropriate to carry out the purposes of this subsection, including regulations
or other guidance which provide for—

(A)

the treatment of
two or more persons as members of a foreign controlled group of entities if
such persons would be the common parent of such group if treated as one
corporation, and

(B)

the treatment of
any member of a foreign controlled group of entities as the common parent of
such group if such treatment is appropriate taking into account the economic
relationships among such
entities.

.

(b)

Effective
date

The amendment made by this section shall apply to payments
made after the date of the enactment of this Act.

302.

Time for
payment of corporate estimated taxes

The percentage under paragraph (2) of
section 561 of the Hiring Incentives to Restore Employment Act in effect on the
date of the enactment of this Act is increased by 3 percentage points.

IV

Budgetary
Effects

401.

Compliance with
Statutory Pay-As-You-Go Act of 2010

The budgetary effects of this Act, for the
purpose of complying with the Statutory Pay-As-You-Go Act of 2010, shall be
determined by reference to the latest statement titled Budgetary Effects
of PAYGO Legislation for this Act, submitted for printing in the
Congressional Record by the Chairman of the House Budget Committee, provided
that such statement has been submitted prior to the vote on passage.